My girlfriend and I have begun having sex recently. The first few times
we did, we used condoms. Lately, we haven't. I always pull out before I
come. Is this still safe? Is it safe to re-enter after this? Someone told
me that if we don't want to use a condom, we should use a spermicide. Is
this safe by itself? I appreciate all that help. Thanx.

Dear Reader,

Let's first clarify what you are trying to prevent: sexually transmitted infections (STIs), pregnancy, or both? In the case of STIs, the answer is a resounding NO! Pulling out, or withdrawal, isn’t an effective method of STI prevention because most disease-causing microorganisms don’t depend on ejaculation for transmission. A condom will only help prevent the spread of STIs if you put it on before sex and leave it on the entire time you are having sex.

If both of you have been tested before you started having sex with each other, you may not be concerned about STIs. If you haven't been tested you may want to consider doing so. You can visit your health care provider or a health center such as Planned Parenthood for STI testing and related services.

As a primary means of pregnancy prevention, withdrawal has several disadvantages. First, there's the pre-ejaculatory fluid on which the withdrawal method has no effect since it's released well before you ejaculate. Pre-ejaculate itself doesn't contain sperm, however it may pick up sperm left in the urethra from a previous ejaculation, and thus, re-inserting your penis after ejaculation (outside of the vagina) does present a risk of pregnancy. Next, and what perhaps has even more of an impact on the effectiveness of the method, is the issue of consistency and self-control. Can you use the withdrawal method correctly and consistently (pulling out prior to ejaculation) each time you have sex? If not, then you might want to think about whether this method is right for you. Of course, you do have the option of emergency contraception.

Withdrawal does have its advantages. It's free and always available. Second, no side effects are associated with this form of contraception. The estimated failure rate for typical use is around 22 percent. When practiced perfectly, some researchers estimate the failure rate to be around 4 percent. This means 4 to 22 women out of every 100 who use withdrawal as their contraceptive method get pregnant.

You also mentioned potentially using spermicides. Used alone, spermicides have one of the highest failure rates of all methods of birth control — between 18 to 28 percent — even higher than withdrawal! If pregnancy prevention is a primary concern for you and your partner, spermicide alone may not be the best contraceptive for you. However, you could use a spermicide in addition to withdrawal. The spermicide would offer a "back-up" in the event that you do not pull out in time. Most drug stores and pharmacies sell a variety of spermicides — you and your girlfriend may want to experiment with a few to find one that works best. Though spermicide is typically easy to use and find, it does have some potential downsides. Some women experience urinary tract infections (UTIs) due to the use of spermicides. Spermicides may also increase the risk of HIV transmission, because it can irritate the skin and make it easier for the virus to get into the body. If you (or your partner) discover that the use of spermicide irritates your skin, you may want to consider a different method of contraception.

If you haven't already, perhaps you and your girlfriend could talk about your concerns and work toward reaching a mutual decision on what form(s) of contraception and/or safer sex you both want to use. Besides the issue of STIs, it’s best to talk about how willing you are to risk having to deal with a pregnancy and what either of you would do if a pregnancy occurred. Withdrawal is definitely less effective than, say, the birth control pill. But, if both of you are okay and comfortable with the risk involved, then you may decide that withdrawal is a good method for the two of you. To make a decision like this, it’s helpful to have as much information as possible. Making a visit to your health care provider to further discuss your contraceptive options and choices may help you and your partner decide what will work best. For more information on contraceptive methods, check out the Contraception category in the Go Ask Alice!Sexual and Reproductive Health archive.

Stay safe!

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